Healthcare Provider Details

I. General information

NPI: 1538122452
Provider Name (Legal Business Name): HENRY FORD VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15051 FORD RD
DEARBORN MI
48126-4698
US

IV. Provider business mailing address

15051 FORD RD
DEARBORN MI
48126-4698
US

V. Phone/Fax

Practice location:
  • Phone: 313-846-7142
  • Fax:
Mailing address:
  • Phone: 313-846-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number824026
License Number StateMI

VIII. Authorized Official

Name: MR. RONALD JESMORE
Title or Position: CHAIRPERSON
Credential:
Phone: 313-584-1000